People over 60 are at higher risk of being diagnosed with lung or bowel cancer as an emergency in hospital than younger people, according to a Cancer Research UK-supported report *, published today by BMJ Open (Thursday).
The researchers also found that women and less affluent people are at higher risk of an emergency lung cancer diagnosis. While being unmarried, divorced or widowed was associated with having bowel cancer diagnosed as an emergency.
The Cancer Research UK review looked at over 20 studies featuring more than 687,000 lung or bowel cancer cases, of which more than 200,000 cases** were diagnosed with cancer after an emergency admission to hospital. Some were admitted after seeing a GP, while others were admitted after going to an A&E department, or directly from a hospital outpatient clinic. The researchers wanted to find out more about why so many patients are diagnosed through this emergency route, particularly as emergency-diagnosed cancers tend to have poorer survival rates.
Almost 40 per cent of lung cancers and 25 per cent of bowel cancers*** in England were diagnosed as an emergency in hospital between 2006 and 2010. Previous research showed that eleven per cent of lung cancer patients with an emergency diagnosis survived their cancer for at least one year, compared to 42 per cent of patients diagnosed following a GP referral under the two-week-wait system. One year survival for emergency-diagnosed bowel cancer patients was 49 per cent compared to 83 per cent for two-week-wait patients.
Lead review author Dr Liz Mitchell, Senior Research Fellow at the Leeds Institute of Health Sciences said: "It may be that some patients don't go to their GP about early cancer symptoms -especially if they live alone - or they become ill very quickly, leading to an emergency diagnosis in hospital. But our review shows that other factors such as a person's age and gender might also have an influence. Knowing more about these influences could help us to find ways of ensuring that more cancers are spotted earlier, when patients often have a better chance of survival."
Sara Hiom, director of early diagnosis at Cancer Research UK said: "We need a better understanding of why some people are having their cancer diagnosis made via an emergency admission. This is important because we know that their survival chances are lower if people are diagnosed this way. This interesting review sheds some light on the factors that could be involved. We're now funding further research on the subject and calling on the Government to ensure more cancers are diagnosed at the earliest possible stage because this can make such a difference for patients."
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Notes to editor
* Elizabeth D Mitchell, Benjamin Pickwell-Smith, Una Macleod. 'Risk factors for emergency presentation with lung and colorectal cancers: a systematic review. DOI: 10.1136/bmjopen-2014-006965
The term 'older patient' varied slightly between the studies included in this review, but included those aged 60 to more than 90. Most classified 'older' as 70/75-plus.
Researchers are from the Leeds Institute of Health Sciences; the John Radcliffe Hospital in Oxford; and the Centre for Health and Population Sciences in Hull.
** The review considered 22 studies involving patients who had not previously had a diagnosis of cancer. Most studies were from the UK (11), with 3 from elsewhere in Europe, 5 from North America, 2 from Australia and 1 from Malaysia.
***Between 2006 and 2010 in England, 38 per cent of lung cancers and 25 per cent of bowel cancers were diagnosed via the emergency route.
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